Many times after bad road traffic accidents, the patient loses one eye, so it is not only the loss of eye and vision that is troubling to the patient, it is also the severe cosmetic deformity that he gets is socially embarrassing, and these patient require good medical health to improve their cosmetic outcome.
I’m Doctor Priti Udhay, an ocular plastic surgeon from DRR Face Aesthetics, Chennai, and I am here to explain this to you today.
So whenever there is a road traffic accident, like you see in this patient, he has severe road traffic accident, all his bones in the nose or the bones around the eyes are fractured and shattered. So these kind of patient, if you just put an artificial eye, the socket itself is displaced out and down, so the eye, the artificial eye will look like it is displaced out and down. So unless you correct the foundation, that is the bony frail work, the artificial eye will not look good. So you will feel that you know, he already lost this eye, all he needs is a cosmetic rehabilitation, why do such a long 5-6 hours surgery for this kind of patient. But that is the primary requirement of this patient, you need to correct the bones first only then the artificial eye will be in the normal place and both the eyes will look symmetrical. So like you can see in this patient, he has lost his eyeball because he had very severe road traffic accident, he has completely shattered bones of the nose as well as the roof and the floor of the orbit, that is the bones which are surrounding the eye are fractured, now in these patient what we do is we make a skull model of the patient from the patient’s CT scan, and we plan the surgery on that model. So we decide how much of bone needs to be moved so that it is comparable to the other side, so we decide how of rotation is needed, and we also contour or we shape the implants on these models and these implants then we use on the patient during the surgery.
Now this patient also has drooping of the eyelid, he has increase distance between the nose and the inner side of the eye, and that also was corrected in the same time. So during surgery, now when we are moving the bones, how will we know whether this bone is in the right place, because the other side the bone is not exposed, so we cannot compare the two sides on table. For that we have a technology called navigation guided surgery or computer assisted surgery, so in that, during surgery we know where exactly we are, whether the bone is now aligned in the right place or not, whether our implants are perfectly correcting the orbit or not, so during surgery we can make sure that the implants are correctly placed, the two sides are same and symmetrical. By using this new technology, you can see in this patient I have corrected the drooping the eyelid, I have corrected the distance between the inner corner and the nose, we have repaired the nose bone and the floor, and he looks pretty nice, still he has some amount of volume lost, but we can correct that with a ball implant later. We have given him a cosmetic eye and you can see he looks completely different and he can now lead a socially acceptable and normal life, in spite of having vision in one eye, he has regained his confidence and can move about happily.